CREATING CONDITIONS FOR CHANGE THE SITUATION OF WOMEN AND CHILDREN IN GUINEA-BISSAU June, 1997 Creating Conditions for Change The Situation of Women and Children in Guinea-Bissau 3 Fax:+31 70 5 899 64 BARCODE: 8 LO: TABLE OF CONTENTS PAGE PART ONE - THE NATIONAL CONTEXT - Some Structural Causes of the Current Situation Chapter One - Population Issues, the Household Economy and Cultural Diversity 1 Chapter Two - Politics and Administration 8 Chapter Three - The Guinean Economy 11 - The Economy 11 - The Public Investment Programme (PIP) and Budget Priorities 13 - Production 17 - Socio-Economic Structure and Access to Resources 20 - New Initiatives in Defining Poverty 22 Chapter Four - Constraints of Socio-Economic Development on Child and Maternal Welfare...26 -Poverty 26 PART TWO - THE SITUATION OF CHILDREN AND WOMEN - Problems and Their Immediates Causes Chapter Five - Social Sectors 30 -Health..... 30 - Infant and Under Five Mortality 30 - Maternal Mortality 39 - Other Health Problems 43 - HealthCare 46 Chapter Six - Social Sectors - Education 53 - Education 53 - Basic Education 53 - Adult Literacy 58 Pre-School Education 60 - Traditional Education 61 - Traditional Non-Formal Education 63 Chapter Seven- Social Sectors -Food Security 66 - Food Security 66 Chapter Eight - Children in Need Special Protection 72 - Introduction 72 - Children in Difficult Circumstances 72 - The Situation of Children and the CRC 75 - Other Facilitation Factors 79 Chapter Nine - The Situation of Women 81 - Introduction 81 - The Economic Role of Women 81 - Practices Harmful to the Health of Women 86 - The Legal Status of Women 88 - Government Policies and Programmes 89 - The future for Women in Guinea-Bissau 91 PART THREE - THE SITUATION OF CHILDREN AND WOMEN - Underlying Causes Chapter Ten - The Current Situation - Health 93 - Introduction 93 - Health Services 93 - Funding Policies 103 Chapter Eleven - The Current Situation - Education '..'. 107 - The Education System 107 - Funding for Basic Education 107 - Professional and Higher Education 110 - Linkages to Other Services Ill - State Adult Literacy and Education 113 -Non-Governmental Organizations and Adult Education 114 Chapter Twelve - Current Situation - Water and Sanitation 117 - Rural Areas 117 - Urban Areas 120 - Underlying Problems Affecting the Sector 122 - National Policy 126 - Resources 127 Chapter Thirteen - Social Communications and Information 130 - Introduction 130 - Modern Social Communication Services 130 - Traditional Social Communication 133 Chapter Fourteen - Involving Civil Society: NGOs in Guinea-Bissau 134 - Introduction 134 - Background to NGOs in Guinea-Bissau 135 - UNICEF Study on NGOs * 137 - NGO Capacity and Interventions * 147 PART FOUR - FUTURE PERSPECTIVES Chapter Fifteen - Future Perspectives 150 TABLEUKABBREFIATIONS ACP Advocacy and Communication Programme ADB African Development Bank ADIM Associacao para o Desenvolvimento Integrado da Mulher (Association for Integrated Development of Women) ADPP Ajuda de Povo para Povo (Assistance from People to People) AFP Acute Flaccid Paralysis AGUIBEF Guinean Association for Family Planning AIDS Acquired Immunodeficiency Syndrome ALTEKNAG Guinean Association for Studies and Alternatives AMIC Friends Association of Children APE Students' Parents Association ASDI Swedish International Agency for Development ART Acute Respiratory Infection BCG Bacillus Calmette Guerin BE Basic Education BI Bamako Initiative CBO Community Based Organizations CECI Canadian Center for Studies and International Cooperation CEDAW Convention for Elimination of Discrimination Against Women CIMA Interministerial Commission for Water CMR Child Mortality Rate CNI National Children's Commission CNLPN National Committee Against Harmful Practices CNSP Children in Need of Special Protection CP Country Programme CRC Convention on the Rights of the Child CWC Community Water Committee 11 DCA Danish Church Aid DD Diarrhoeal Diseases DEPRO Department of Programmes DGEEA General Directorate of Basic Education and Literacy DGEMS General Directorate of Middle and High Education DHS Demography Household Survey DPT3 Diphtheria, Pertussis, Tetanus Vaccine, 3rd Doses EAMR Girls and Women's Education and Literacy ED Essential Drugs EPI Expanded Programme of Immunization FGM Female Genital Mutilation GCO Greeting Cards Operation GDI Gender Difference Index GE Girls Education GOGB Government of Guinea-Bissau GR General Resources GRUMEDIA Media Group HC Health Center HDI Human Development Index HMC Health Management Committee IIIV2 Human Immunodeficiency Virus, Type 2 IEC Information, Education and Communication IMEP Integrated Monitoring and Evaluation Plan IMR Infant Mortality Rate INDE National Institute for the Development of Education INEP National Institute for Studies and Research IRC International Reference Center IRM Information Resources Management HI KAP Knowledge, Attitudes, Practices LFA Logical Framework Approach LGDH Guinean NGO for Human Rights MASPF Ministry of Social Affairs and Women's Promotion MEIRN Ministry of Energy, Industry and Natural Resources MICS Multiple Indicator Cluster Survey MINSAP Ministry of Public Health MMR Maternal Mortality Rate MOE Ministry of Education MTR Mid-Term Review NGO Non-Governmental Organization NHDP National Health Development Plan OGE Government Global Budget OPV3 Oral Polio Vaccine, 3rd Doses ORS Oral Rehydration Salt ORT Oral Rehydration Therapy PEC Primary Environmental Care PHC Primary Health Care Plan International Non-Governmental Organization PNDS National Programme for Sanitary Development PPDPC Programme for Policy Development and Programme Coordination PPA Project Plan of Action PPM Project Planning Matrix PPO Programme Plan of Operations PRA Participatory Rural Appraisal PSCW Programme for the Survival of Children and Women Radda Barmen Swedish NGO RHT Regional Health Teams IV SAB Bissau Autonomous Sector SANPLAT Sanitation Platform SAP Structural Adjustment Ps^gramri^ SEP Secretariat of State for Planning SF Supplementary Funds SITAN Situation Analysis SNIECS Education, Inform. & Communication National Service for Health SNV Netherlands Volunteers Organization STD Sexually Transmitted Diseases TBA Traditional Birth Attendant TT2 Tetanus Toxoid, 2nd Doses TOT Training of Trainers UEMOA Economic Monetary Union of Western Africa UICN International Union for Conservation of Nature UN United Nations UNDP United Nations Development Programme UNESCO United Nations Education, Science and Culture Organization UNFPA United Nations Fund for Population Activities UNICEF United Nations Children's Fund USB Village Health Post USD United States Dollars VAD Vitamin A Deficiency Vit. A Vitamin A WB World Bank WES Water and Environmental Sanitation WFP World Food Programme WID Women in Development WHO World Health Organization OtMTtm CWDITIONS FOR CHANGE PART ONE THE NATIONAL CONTEXT Some Structural Causes of the Current Situation Government of the Republic of Guinea Bissau United Nations Children's Fund CHEATING CONDITIONS FOR CHANGE CHAPTER ONE 1.0 POPULATION ISSUES, THE HOUSEHOLD ECONOMY AND CULTURAL DIVERSITY The population at the 1991 Census was just over 983,000 (Table 1). Estimates based upon a 2.2 percent per annum growth rate give a 1995 population of 1,081,000 people, and a 2002 figure of 1,268,000 (the end year of the next GOGB/UNICEF Country Programme). Around 363,000 (37 percent) live in the three northern provinces, while 144,000 (11 percent) live in the south. There is already evidence of a strong rural-urban exodus, with a far higher rate of growth in urban areas compared with the rural interior, especially the islands. In 1991, Bissau Autonomous Sector (BAS, the area immediately around the capital) had grown to nearly 200,000, at a rate of 5.5 percent per annum compared with between 1 and 2 percent in most rural areas. At this rate of growth, the population of Bissau city will be well over 200,000 by 1996, and is estimated to be around 303,000 by 2002 (24 percent of the total). TABLE 1 Population, 1991, 1995 1^91 1995 Annual Growth Rate(%) Bissau Autonomous Sector 197.610 245.159 5.5 Northern Region Biombo 60.420 62.873 1.0 Cacheu 146.980 152.948 1.0 Oio 156.084 163.712 1.2 Sub-Total 363.484 379.533 1.1 Eastern Region Bafata 143.367 153.972 1.7 Gabu 134.981 147.257 2.1 Sub-Total 278.348 301.229 1.9 Southern Region Bolama/Bijagos 26.691 27.337 0.3 Quinara 44.793 48.296 1.8 Tombali 72.441 79.650 2.3 Sub-Total 143.925 155.283 1.8 TOTAL 983.367 1.081.204 2.3 Source: General Census of Population and Housing, March 1991 In addition, the two main interior towns of Bafata and Gabu have also grown rapidly, particularly the latter which sits astride key international trade routes to the rest of the region. Together with the other provincial towns, an additional 50,000 people at least will be living in urban or peri-urban Government of the Republic of Guinea Bissau United Nations Children ,s I< and CREATING CONDtttONS FOR CHANGE areas outside Bissau by 2002, with a host of specific problems and needs which only explicitly urban-oriented programmes can resolve, Demographic Structure The population of Guinea Bissau is very young, with nearly 47 percent under 15 years of age and 29 percent under eight years (Table 2). The ONICEF key target population of infants under 1 year make up 3.3 percent of the population, while the 1-7 age group is 25 percent, evenly divided between girls and boys. This represents a target group of some 36,000 infants and 270,000 older children between 1 and 7 years now, and a likely figure of 42,000 and 322,000 for each group respectively by 2002. Overall, women represent 51.6% while men represent 48.4% of the population. The percentage of women in the population is higher than that of men in all the regions of the country. The predominance of women is higher too in the 15-45 age group (21 percent versus 17.5 percent), and there is evidence that the proportion of women in this key economically active age group is higher still in rural areas. These figures reflect the emigration of young men both from rural areas to the city, and from Guinea Bissau to other countries in the region and Europe. TABLE 2 Population by Age Group and Sex, 1991 : : i^f-^G^i:.,: i:||4lii|l1381llllirAli , ., :•:.